11 Signs of Borderline Personality Disorder

Here's what you should know about this complex and often-misunderstood mental illness.

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According to the National Library of Medicine (NLM), personality disorders are long-term, unhealthy patterns of thoughts, emotions, and actions. Of the 10 personality disorders—which include obsessive-compulsive personality disorder (OCPD), paranoid personality disorder, and narcissistic personality disorder—borderline personality disorder (BPD) tends to be the most misunderstood.

The disorder's name alone is enough to spark confusion since "borderline" seems to imply that BPD is not a full-blown problem. Experts originally felt BPD fell on the border between psychosis (severe mental disorder) and neurosis (mild mental illness) and didn't warrant being classified as a distinct disorder, said John Oldham, MD, professor of Psychiatry and Behavioral Sciences at Baylor College of Medicine in Houston. It wasn't until the DSM-III was published in 1980 that BPD was listed as its own disorder. Nevertheless, "borderline" stuck.

Since then, experts have grown to better understand and define the complex illness. There's ample evidence that it's "partly inherited genetically and partly a function of stressful experiences during growth and development that leads to some pretty significant interference in successful functioning," though experts still aren't 100% sure of the underlying cause, Dr. Oldham said.

Wendy Behary, a New Jersey-based licensed clinical social worker and founding fellow of the Academy of Cognitive Therapy, confirmed many of her patients with BPD had some form of loss, trauma, or abandonment in their childhood, which they try to reconcile as adults. That said, having a tough upbringing or family history of BPD doesn't mean you're destined to have the disorder, Dr. Oldham explained. "It just means that you have that risk factor."

Are There Telltale Signs?

BPD impacts nearly 1.6% of adults in the United States, according to the NLM. That stat may seem small, but probably fails to represent the entire BPD population, Behary said. BPD can be difficult to diagnose because many of the symptoms overlap with other mental illnesses such as depression, bipolar, and narcissistic personality disorder.

Furthermore, borderline happens along a spectrum. "At one end there's a very low-functioning individual, who can barely manage day-to-day life, and at the other is someone who's very high functioning," Behary said. People may spend their entire lives unaware they have a mental illness and never seek resources to ease some of their symptoms.

Based on the latest diagnostic model in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision (DSM-5-TR), here are the signs you or someone you know might have BPD, based on the latest diagnostic model.

Self-Esteem Shifts

People with BPD tend to deal with overwhelming self-doubt. These individuals have incredibly unstable self-esteem, so they rely heavily on external praise and approval to help define their identity, Dr. Oldham said. "Underneath that, there's a sense of inferiority and incompleteness," Dr. Oldham explained. People with BPD may even copy others' actions and behaviors because "their ability to be independent and autonomous is very impaired."

Avoiding Thinking About the Future

While you certainly don't need to have your entire life mapped out, most people have at least vague aspirations and plans. People who have BPD often lack any sort of self-direction. "There's very little sense of knowing what you want out of life or what you want to work toward," Dr. Oldham said.

Trouble Empathizing

"Interpersonally, there's a real impairment in being able to see yourself from the outside and see others from the inside," Dr. Oldham said. In other words, people with BPD have a harder time handling both self-awareness and empathy. "There's a lack of understanding about how your own behavior impacts people, so when your emotions are out of control, it doesn't register that this causes stress for others," Dr. Oldham added. This lack of awareness is one reason people with borderline tend to have trouble maintaining healthy long-term relationships.

Chaotic Relationships

Individuals with BPD frequently find themselves in physically or emotionally abusive relationships, Behary said. In many cases, they'll gravitate toward partners who they hope can fill the needs that weren't met in their childhoods, which often leads to staying in toxic relationships.

With BPD, people tend to be excessively needy, intense, and mistrusting in relationships, Dr. Oldham added. "There's such a heightened anxiety you'll lose the person that's close to you, that you actually drive the other person away—it becomes a self-fulfilling prophecy."

Romantic relationships aren't the only stormy ones; people with BPD tend to swing from extreme closeness to extreme dislike with friends and family as well. It's these interpersonal relationships where highly functioning people with BPD often realize they have a problem.

Overwhelming Anxiety

We all get anxious from time to time, but for those with BPD, anxiety is all-consuming, characterized by intense feelings of nervousness, tenseness, or panic. These emotions often arise as a hypersensitive response to other people's actions, Dr. Oldham said. People with BPD have an extreme desire to be needed and liked, and it can be debilitating. As a result of this heightened anxiety, people with borderline may express their emotions in explosive, inappropriate ways.

Constant Fear of Abandonment

The fear of being alone, rejected, or abandoned is a telling sign of BPD. These insecurities breed irrational reactions and jealous, paranoid behaviors, such as checking a partner's email for clues they might bail, said David Mattila, a New York City-based licensed clinical social worker and cognitive and schema therapist. "This insecurity can even lead to more extreme and manipulative behaviors," Mattila said, such as telling a partner, "If you don't call me when you say you will, I'm going to kill myself." For the person with BPD, it all folds into their desperate desire to avoid abandonment.

Depression

BPD is frequently misdiagnosed as chronic depression. Though depression is common in people who have BPD, their symptoms tend to manifest a little differently. "It's a very heavy, profound depression," Behary said. "It's loaded with this chronic feeling they have no value and a pervasive sense that nothing matters."

Frequent Mood Swings

Erratic moods are a symptom of BPD, making it easy to mistake for bipolar disorder. "It's not the same persistent mood state you'd see in someone with bipolar, characterized by severe manic or depressed episodes that can last for weeks or longer," Dr. Oldham said.

Instead, BPD moods change rapidly and are often triggered by overreactions to external events. For example, if a colleague was too preoccupied to say hello in the hallway, someone with BPD might suddenly become extremely agitated, Dr. Oldham said. "Small things that wouldn't even occur to other people to take personally are completely overreacted to and internalized."

Uncontrollable Anger

It's common for people with BPD to react in a way that seems exaggerated or disproportional to an event. For example, Mattila explained, if your partner was supposed to pick you up at 7 and didn't arrive until 7:30, the appropriate response would be irritation. Someone with BPD will react by saying something like, "'I'm breaking up with you, you don't love me, I hate you, you're never there for me,' and so on," Mattila said.

People with BPD also frequently project their problems and emotions onto others, Dr. Oldham said. "They can't tolerate [acknowledging] that they're the ones with the problem, so they blame others instead," Dr. Oldham added. "It's virtually toxic for them to own that their rage and anger is not justified by another person, but actually coming from inside."

Inability To Control Actions

People with BPD are often impulsive: They'll drop thousands of dollars on a new television without considering how it will impact their finances, have unprotected sex with multiple partners, or engage in other risky behavior. Dr. Oldham said they can't help it—their minds work like hyperactive motors in cars with broken breaks. They just can't stop.

At times, risk taking tendencies can even lead to cutting or other extreme self-harm, Dr. Oldham added. "It helps them turn off their emotions and produce release." This generally happens when people with BPD feel extremely dissociated, detached, or numb for too long.

Suicidal Thoughts

While not an official symptom of borderline, Dr. Oldham pointed out there's a high rate of suicidal ideation and suicide attempts in the BPD population. According to a May 2019 Medicina study, the suicide rate for those with BPD has been up to 10%. "The risk is higher in these patients because they can be impulsive," Dr. Oldham said. "So instead of being so depressed they can't get out of bed, they might really see suicide as the only logical solution to stop the pain."

How Do I Know If I Have BPD?

According to the American Psychiatric Association, an individual would need to show impairments in self-functioning (through issues with identity or self-direction) and interpersonal functioning (through issues with empathy or intimacy)—along with any of the following symptoms:

  • Overwhelming anxiety
  • Fear of abandonment
  • Depression
  • Frequent mood swings
  • Uncontrollable anger
  • Impulsivity
  • Risk taking

If you're still not sure, talk to your healthcare provider or make an appointment with a psychologist.

Where To Get Help

Unlike treatments for some mental illnesses, the primary treatment for BPD is psychotherapy, not medication—though medication may be recommended, according to the National Institute of Mental Health (NIMH). Dr. Oldham suggested dialectical behavioral therapy (DBT), a specific kind of cognitive behavioral therapy (CBT) developed in the 1980s to better treat BPD. Dr. Oldham also recommended looking into schema therapy, mentalization-based therapy, or any other kind that appeals to you. Just be sure to find a specialist who has experience with treating BPD, Mattila added.

For additional support and resources, you can also contact the Personality Disorder Awareness Network (PDAN) or National Education Alliance for BPD (NEABPD).

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